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Maria PA, Vuurberg G, Kerkhoffs GMMJ. Exploring influences and risk of bias of studies on return to sport and work after lateral ankle sprain: A systematic review and meta-analysis. World J Meta-Anal 2024; 12:87026. [DOI: 10.13105/wjma.v12.i1.87026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/26/2023] [Accepted: 01/02/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Lateral ankle sprains are the most common traumatic musculoskeletal injuries of the lower extremity, with an incidence rate of 15%-20%. The high incidence and prevalence highlights the economic impact of this injury. Ankle sprains lead to a high socioeconomic burden due to the combination of the high injury incidence and high medical expenses. Up to 40% of patients who suffer from an ankle sprain develop chronic ankle instability. Chronic instability can lead to prolonged periods of pain, immobility and injury recurrence. Identification of factors that influence return to work (RTW) and return to sports (RTS) after a lateral ankle sprain (LAS) may help seriously reduce healthcare costs.
AIM To explore which factors may potentially affect RTW and RTS after sustaining an LAS.
METHODS EMBASE and PubMed were systematically searched for relevant studies published until June 2023. Inclusion criteria were as follows: (1) Injury including LAS or chronic ankle instability; (2) Described any form of treatment; (3) Assessment of RTW or RTS; (4) Studies published in English; and (5) Study designs including randomized controlled clinical trials, clinical trials or cohort studies. Exclusion criteria were: (1) Studies involving children (age < 16 year); or (2) Patients with concomitant ankle injury besides lateral ankle ligament damage. A quality assessment was performed for each of the included studies using established risk of bias tools. Additionally quality of evidence was assessed using the GRADEpro tool in cases where outcomes were included in the quantitative analysis. A best evidence synthesis was performed in cases of qualitative outcome analysis. For all studied outcomes suitable for quantitative analysis a forest plot was created to calculate the effect on RTW and RTS.
RESULTS A total of 8904 patients were included in 21 studies, 10 randomized controlled trials, 7 retrospective cohort studies and 4 prospective cohort studies. Fifteen studies were eligible for meta-analysis. The overall RTS rate ranged were 80% and 83% in the all treatments pool and surgical treatments pool, respectively. The pooled mean days to RTS ranged from 23-93 d. The overall RTW rate was 89%. The pooled mean time to RTW ranged from 5.8-8.1 d. For patients with chronic ankle instability, higher preoperative motivation was the sole factor significantly and independently (P = 0.001) associated with the rate of and time to RTS following ligament repair or reconstruction. Higher body mass index was identified as a significant factor (P = 0.04) linked to not resuming sports or returning at a lower level (median 24, range 20-37), compared to those who resumed at the same or higher level (median 23, range 17-38). Patients with a history of psychological illness or brain injury, experienced a delay in their rehabilitation process for sprains with fractures and unspecified sprains. The extent of the delayed rehabilitation was directly proportional to the increased likelihood of experiencing a recurrence of the ankle sprain and the number of ankle-related medical visits. We also observed that 10% of athletes who did return to sport after lateral ankle sprain without fractures described non-ankle-related reasons for not returning.
CONCLUSION All treatments yielded comparable results, with each treatment potentially offering unique advantages or benefits. Preoperative motivation may influence rehabilitation after LAS. Grading which factor had a greater impact was not possible due to the lack of comparability among the included patients.
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Affiliation(s)
- Priscilla A Maria
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC-Location AMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Academic Center for Evidence-based Sports medicine, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Faculty of Medicine, University of Amsterdam, Amsterdam 1105 AZ, Netherlands
| | - Gwendolyn Vuurberg
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC-Location AMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Academic Center for Evidence-based Sports medicine, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Department of Radiology and Nuclear Medicine, Rijnstate Arnhem, Arnhem 6815AD, Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
| | - Gino MMJ Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC-Location AMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Academic Center for Evidence-based Sports medicine, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Faculty of Medicine, University of Amsterdam, Amsterdam, 1105 AZ, Netherlands
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Mehrab M, Wagner RK, Vuurberg G, Gouttebarge V, de Vos RJ, Mathijssen NMC. Risk Factors for Musculoskeletal Injury in CrossFit: A Systematic Review. Int J Sports Med 2022; 44:247-257. [PMID: 36174660 PMCID: PMC10072928 DOI: 10.1055/a-1953-6317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The objective of this systematic review was to identify potential risk factors for injury in CrossFit participants. Embase, Medline, Web of Science, Cochrane, CINAHL, Google Scholar, and SportDiscuss databases were all searched up to June 2021. Cohort studies that investigated risk factors for CrossFit injuries requiring medical attention or leading to time loss in sports were included. A best-evidence synthesis was performed combining all the outcomes from prospective cohort studies. From 9,452 publications identified, we included three prospective cohort studies from which two had a low risk of bias and one a high risk of bias. The studies examined 691 participants of whom 172 sustained an injury. There was limited evidence that switching between prescribed and scaled loads during training is associated with increased injury risk and that increased duration of participation is a protective factor for injury. This could mean that novice CrossFit athletes and those increasing their training load should have closer supervision by CrossFit coaches. These risk factors should be considered when developing preventive interventions.
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Affiliation(s)
- Mirwais Mehrab
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Robert Kaspar Wagner
- Department of Orthopaedic Surgery, Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands, Amsterdam, Netherlands.,Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands, Amsterdam, Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands, Amsterdam, Netherlands
| | - Gwendolyn Vuurberg
- Department of Orthopaedic Surgery, Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands, Amsterdam, Netherlands.,Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands, Amsterdam, Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands, Amsterdam, Netherlands
| | - Vincent Gouttebarge
- Department of Orthopaedic Surgery, Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands, Amsterdam, Netherlands.,Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands, Amsterdam, Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands, Amsterdam, Netherlands.,Section Sports Medicine, University of Pretoria, Pretoria, South Africa
| | - Robert-Jan de Vos
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, Netherlands
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Vuurberg G, Tümer N, Sierevelt I, Dobbe JGG, Hemke R, Wiegerinck JJ, Maas M, Kerkhoffs GMMJ, Tuijthof GJM. Translation of 3D Anatomy to 2D Radiographic Angle Measurements in the Ankle Joint: Validity and Reliability. Foot & Ankle Orthopaedics 2022; 7:24730114221112945. [PMID: 35898795 PMCID: PMC9310239 DOI: 10.1177/24730114221112945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The objective consisted of 2 elements, primarily to define 2 bone geometry variations of the ankle that may be of prognostic value on ankle instability and secondly to translate these bone variations from a 3D model to a simple 2D radiographic measurement for clinical use. Methods: The 3D tibial and talar shape differences derived from earlier studies were translated to two 2D radiographic parameters: the medial malleolar height angle (MMHA) and talar convexity angle (TCA) respectively to ensure clinical use. To assess validity, the MMHA and TCA were measured on 3D polygons derived from lower leg computed tomographic (CT) scans and 2D digitally reconstructed radiographs (DRRs) of these polygons. To assess reliability, the MMHA and TCA were measured on standard radiographs by 2 observers calculating the intraclass correlation coefficient (ICC). Results: The 3D angle measurements on the polygons showed substantial to excellent agreement with the 2D measurements on DRR for both the MMHA (ICC 0.84-0.93) and TCA (ICC 0.88-0.96). The interobserver reliability was moderate with an ICC of 0.58 and an ICC of 0.64 for both the MMHA and TCA, respectively. The intraobserver reliability was excellent with an ICC of 0.96 and 0.97 for the MMHA and the TCA, respectively. Conclusion: Two newly defined radiographic parameters (MMHA and TCA) are valid and can be assessed with excellent intraobserver reliability on standard radiographs. The interobserver reliability was moderate and indicates training is required to ensure uniformity in measurement technique. The current method may be used to translate more variations in bone shape prior to implementation in clinical practice. Level of Evidence: Level III, cohort study.
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Affiliation(s)
- Gwendolyn Vuurberg
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
- Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Nazli Tümer
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), the Netherlands
| | - Inger Sierevelt
- Specialized Centre for Orthopedic Research and Education (SCORE), Xpert Orthopedics, Amsterdam, the Netherlands
- Spaarne Gasthuis Academy, Orthopedic Department, Hoofddorp
| | - Johannes G. G. Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Robert Hemke
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
- Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan Joost Wiegerinck
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Bergman Clinics, Rijswijk, the Netherlands
| | - Mario Maas
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
- Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - Gabriëlle J. M. Tuijthof
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
- Department of Research Engineering, Faculty Health, Medicine & Life Science, Maastricht University, Maastricht, the Netherlands
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Vuurberg G, Dahmen J, Dobbe IGG, Kleipool RP, Hayat B, Sierevelt IN, Streekstra G, Kerkhoffs GMMJ, Stufkens SAS. Lower leg symmetry: a Q3D-CT analysis. Surg Radiol Anat 2022; 44:851-860. [PMID: 35534775 PMCID: PMC9246803 DOI: 10.1007/s00276-022-02940-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/07/2022] [Indexed: 10/29/2022]
Abstract
PURPOSE In fracture and realignment surgery, the contralateral unaffected side is often used as a model or template for the injured bone even though clinically valuable quantitative data of bilateral symmetry are often unavailable. Therefore, the objective of the present study was to quantify and present the bilateral symmetry of the tibia and fibula. METHODS Twenty bilateral lower-leg CT scans were acquired in healthy volunteers. The left and right tibia and fibula were segmented resulting in three-dimensional polygons for geometrical analyses (volume, surface and length). The distal and proximal segment of the right tibia of each individual was subsequently matched to the left tibia to quantify alignment differences (translation and rotation). Bone symmetry on group level was assessed using the Student's t test and intra-individual differences were assessed using mixed-models analyses. RESULTS Intra-individuals differences were found for tibia volume (5.2 ± 3.3 cm3), tibia surface (5.2 ± 3.3 cm2), translations in the lateral (X-axis; 9.3 ± 8.9 mm) and anterior direction (Y-axis; 7.1 ± 7.0 mm), for tibia length (translation along Z-axis: 3.1 ± 2.4 mm), varus/valgus (φz: 1.7o ± 1.4°), and endotorsion/exotorsion (φz: 4.0o ± 2.7°). CONCLUSION This study shows intra-individual tibia asymmetry in both geometric and alignment parameters of which the surgeon needs to be aware in pre-operative planning. The high correlation between tibia and fibula length allows the ipsilateral fibula to aid in estimating the original tibia length post-injury. Future studies need to establish whether the found asymmetry is clinically relevant when the contralateral side is used as reference in corrective surgery. LEVEL OF EVIDENCE III cohort study.
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Affiliation(s)
- Gwendolyn Vuurberg
- Amsterdam UMC, Department of Orthopedic Surgery, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands. .,AMC/VUmc IOC Research Center, Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands. .,Amsterdam UMC, Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands.
| | - Jari Dahmen
- Amsterdam UMC, Department of Orthopedic Surgery, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,AMC/VUmc IOC Research Center, Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Iwan G G Dobbe
- Amsterdam UMC, Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Roeland P Kleipool
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam UMC, Department of Medical Biology, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Batur Hayat
- Amsterdam UMC, Department of Orthopedic Surgery, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Specialized Centre for Orthopedic Research and Education (SCORE), Xpert Orthopedics, Amsterdam, The Netherlands
| | - Geert Streekstra
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Amsterdam UMC, Department of Orthopedic Surgery, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,AMC/VUmc IOC Research Center, Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Sjoerd A S Stufkens
- Amsterdam UMC, Department of Orthopedic Surgery, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,AMC/VUmc IOC Research Center, Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
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5
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Bech NH, van Dijk LA, de Waard S, Vuurberg G, Sierevelt IN, Kerkhoffs GMMJ, Haverkamp D. Integrity of the hip capsule measured with magnetic resonance imaging after capsular repair or unrepaired capsulotomy in hip arthroscopy. World J Orthop 2022; 13:400-407. [PMID: 35582156 PMCID: PMC9048497 DOI: 10.5312/wjo.v13.i4.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/02/2021] [Accepted: 03/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Current literature shows no clear answer on the question how to manage the capsule after hip arthroscopy. Regarding patient reported outcome measures there seems to be no difference between capsular repair or unrepaired capsulotomy.
AIM To evaluate and compare the integrity of the hip capsule measured on a magnetic resonance imaging (MRI) scan after capsular repair or unrepaired capsulotomy.
METHODS A case series study was performed; a random sample of patients included in a trial comparing capsular repair vs unrepaired capsulotomy had a postoperative MRI scan. The presence of a capsular defect and gap size were independently evaluated on MRI.
RESULTS A total of 28 patients (29 hips) were included. Patient demographics were comparable between treatment groups. There were 2 capsular defects in the capsular repair group and 7 capsular defects in the unrepaired capsulotomy group (P = 0.13). In the group of patients with a defect, median gap sizes at the acetabular side were 5.9 mm (range: 2.7-9.0) in the repaired and 8.0 mm (range: 4.5-18.0) in the unrepaired group (P = 0.462). At the muscular side gap sizes were 6.6 mm (range: 4.1-9.0) in the repaired group and 11.5 mm (range: 3.0-18.0) in the unrepaired group (P = 0.857). The calculated Odds ratio (OR) for having a capsular defect with an increasing lateral center-edge (CE) angle was 1.12 (P = 0.06). The OR for having a capsular defect is lower in the group of patients that underwent a labral repair with an OR of 0.1 (P = 0.05).
CONCLUSION There is no significant difference in capsular defects between capsular repair or unrepaired capsulotomy. Regarding clinical characteristics our case series shows that a larger CE angle increases the likelihood of a capsular defect and the presence of a labral repair decreases the likelihood of a capsular defect.
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Affiliation(s)
- Niels H Bech
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam 1105 AZ, Netherlands
- Department of Orthopedic Surgery, Xpert Orthopedic Surgery Clinic, Amsterdam 1101 EA, Netherlands
- Department of Orthopedic Surgery, Tergooi Ziekenhuis, Hilversum 1213 XZ, Netherlands
| | - Lode A van Dijk
- Department of Orthopedic Surgery, Tergooi Ziekenhuis, Hilversum 1213 XZ, Netherlands
| | - Sheryl de Waard
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam 1105 AZ, Netherlands
| | - Gwendolyn Vuurberg
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem 6815 AD, Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam 1105 AZ, Netherlands
| | - Inger N Sierevelt
- Department of Orthopedic Surgery, Xpert Orthopedic Surgery Clinic, Amsterdam 1101 EA, Netherlands
- Centre for Orthopaedic Research, Spaarne Ziekenhuis, Hoofddorp 2134 TM, Netherlands
| | - Gino MMJ Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam 1105 AZ, Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam University Medical Center, Amsterdam 1105 AZ, Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Amsterdam UMC/IOC Research Center, Amsterdam 1105 AZ, Netherlands
| | - Daniël Haverkamp
- Department of Orthopedic Surgery, Xpert Orthopedic Surgery Clinic, Amsterdam 1101 EA, Netherlands
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Kleipool RP, Stufkens SAS, Dahmen J, Vuurberg G, Streekstra GJ, Dobbe JGG, Blankevoort L, Knupp M. Difference in orientation of the talar articular facets between healthy ankle joints and ankle joints with chronic instability. J Orthop Res 2022; 40:695-702. [PMID: 33913551 PMCID: PMC9291144 DOI: 10.1002/jor.25068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
Since both the talocrural and subtalar joints can be involved in chronic ankle instability, the present study assessed the talar morphology as this bone is the key player between both joint levels. The 3D orientation and curvature of the superior and the posteroinferior facet between subjects with chronic ankle instability and healthy controls were compared. Hereto, the talus was segmented in the computed tomography images of a control group and a chronic ankle instability group, after which they were reconstructed to 3D surface models. A cylinder was fitted to the subchondral articulating surfaces. The axis of a cylinder represented the facet orientation, which was expressed by an inclination and deviation angle in a coordinate system based on the cylinder of the superior talar facet and the geometric principal axes of the subject's talus. The curvature of the surface was expressed as the radius of the cylinder. The results demonstrated no significant differences in the radius or deviation angle. However, the inclination angle of the posteroinferior talar facet was significantly more plantarly orientated (by 3.5°) in the chronic instability group (14.7 ± 3.1°) compared to the control group (11.2 ± 4.9°) (p < 0.05). In the coronal plane this corresponds to a valgus orientation of the posteroinferior talar facet relative to the talar dome. In conclusion, a more plantarly and valgus orientated posteroinferior talar facet may be associated to chronic ankle instability.
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Affiliation(s)
- Roeland P. Kleipool
- Department of Medical Biology, Amsterdam UMCUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands,Academic Center for Evidence‐Based Sports Medicine (ACES)AmsterdamThe Netherlands
| | - Sjoerd A. S. Stufkens
- Academic Center for Evidence‐Based Sports Medicine (ACES)AmsterdamThe Netherlands,Department of Orthopedic Surgery, Amsterdam UMCUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research CenterAmsterdamThe Netherlands
| | - Jari Dahmen
- Academic Center for Evidence‐Based Sports Medicine (ACES)AmsterdamThe Netherlands,Department of Orthopedic Surgery, Amsterdam UMCUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research CenterAmsterdamThe Netherlands
| | - Gwendolyn Vuurberg
- Academic Center for Evidence‐Based Sports Medicine (ACES)AmsterdamThe Netherlands,Department of Orthopedic Surgery, Amsterdam UMCUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research CenterAmsterdamThe Netherlands,Department of Radiology and Nuclear medicine, Amsterdam UMCUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands,Department of Radiology and Nuclear medicineRijnstate ZiekenhuisArnhemThe Netherlands
| | - Geert J. Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam UMCUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
| | - Johannes G. G. Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam UMCUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
| | - Leendert Blankevoort
- Academic Center for Evidence‐Based Sports Medicine (ACES)AmsterdamThe Netherlands,Department of Orthopedic Surgery, Amsterdam UMCUniversity of Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research CenterAmsterdamThe Netherlands
| | - Markus Knupp
- Mein Fusszentrum, BaselUniversity of BaselSwitzerland
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Dahmen J, Altink JN, Vuurberg G, Wijdicks CA, Stufkens SAS, Kerkhoffs GMMJ. Clinical efficacy of the Ankle Spacer for the treatment of multiple secondary osteochondral lesions of the talus. World J Orthop 2022; 13:178-192. [PMID: 35317406 PMCID: PMC8891659 DOI: 10.5312/wjo.v13.i2.178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/18/2021] [Accepted: 01/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Ankle Spacer was developed as a joint-sparing alternative to invasive end-stage surgeries. Currently, there are no clinical studies on the Ankle Spacer.
AIM To describe the operative technique and the clinical efficacy of the Ankle Spacer for the treatment of multiple, cystic osteochondral lesions of the talus in patients with failed prior operative treatment.
METHODS This is a prospective study during which patients were assessed preoperatively, at 2- and 6 wk, and at 3, 6, 12 and 24 mo postoperatively. Patients with multiple, cystic or large (≥ 15 mm) osteochondral lesions of the talus after failed prior surgery were included. The primary outcome measure was the numeric rating scale (NRS) for pain during walking at 2 years postoperatively. Secondary outcome measures included the NRS in rest and during stair climbing, the American Orthopaedic Foot and Ankle Society Hindfoot Score, the Foot and Ankle Outcome Score, the Short- Form 36 physical and mental component scale, and the Range of Motion (ROM). Radiographic evaluations were conducted to evaluate prosthetic loosening and subsidence. Revision rates and complications were also assessed.
RESULTS Two patients underwent an Ankle Spacer implantation on the talus. The NRS during walking improved from 6 and 7 preoperatively to 2 and 2 points postoperatively at 2 years, in patient 1 and 2, respectively. The other patient-reported outcome measures also improved substantially. There were no re-operations nor complications. Radiological imaging showed no loosening of the implant and no change of implant position.
CONCLUSION The Ankle Spacer showed clinically relevant pain reduction during walking, improvement in clinical outcomes as assessed with PROMs, and no complications or re-operations. This treatment option may evolve as a joint-sparing alternative to invasive end-stage surgeries.
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Affiliation(s)
- Jari Dahmen
- Department of Orthopedic Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands
| | - J Nienke Altink
- Department of Orthopedic Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands
| | - Gwendolyn Vuurberg
- Department of Orthopedic Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands
| | - Coen A Wijdicks
- Department of Orthopedic Research, Arthrex, Naples, FL 34108, United States
| | - Sjoerd AS Stufkens
- Department of Orthopedic Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands
| | - Gino MMJ Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands
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8
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Kleipool RP, Vuurberg G, Stufkens SAS, van der Merwe AE, Oostra RJ. Bilateral symmetry of the subtalar joint facets and the relationship between the morphology and osteoarthritic changes. Clin Anat 2019; 33:997-1006. [PMID: 31749217 PMCID: PMC7540665 DOI: 10.1002/ca.23525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/08/2019] [Indexed: 11/06/2022]
Abstract
There is a paucity in the literature regarding bilateral symmetry between the facets of the subtalar joint. Often surgeons use the contralateral side as a reference when dealing with a fracture or other joint pathology. Moreover, the presence of osteoarthritic (OA) changes in the subtalar joint is suggested to have a relation with its morphology. In this study, we addressed both these issues. Forty pairs of cadaveric tali and calcanei were analyzed by dissection and measurement. Twenty pairs of asymptomatic calcanei were morphologically analyzed by computer tomography imaging. In the cadaveric feet, the length and width of the facets, the number and interfacet connections, the intersection angle, and the presence of OA changes were registered. In the healthy feet, the orientation and curvature of the posterior facet were analyzed based on cylinder fittings. Bilateral symmetry was tested with paired Student's t tests. Significant associations between morphometric parameters and the presence of OA changes were tested with generalized estimating equation logistic regression models. The morphometric data demonstrated a high degree of bilateral symmetry. The types of tali and calcanei between left and right differed in about one-fifth of the individuals. No significant interactions were found between morphological parameters and the presence of OA changes. Only age had a significant association. There was a high degree of symmetry in the subtalar joints facets. No significant associations were found between OA changes and morphological features, whereas other studies did. Further research is needed to explore this relationship in further detail. Clin. Anat., 33:997-1006, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Roeland P Kleipool
- Department of Medical Biology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
| | - Gwendolyn Vuurberg
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC, IOC Research Center, Amsterdam, The Netherlands
| | - Sjoerd A S Stufkens
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC, IOC Research Center, Amsterdam, The Netherlands
| | - Alie E van der Merwe
- Department of Medical Biology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Roelof-Jan Oostra
- Department of Medical Biology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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9
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Vuurberg G, Altink N, Rajai M, Blankevoort L, Kerkhoffs GMMJ. Weight, BMI and stability are risk factors associated with lateral ankle sprains and chronic ankle instability: a meta-analysis. J ISAKOS 2019; 4:313-327. [PMID: 33835938 DOI: 10.1136/jisakos-2019-000305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/29/2019] [Accepted: 09/06/2019] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Lateral ankle sprains (LAS) are common in the general population and may lead to chronic ankle instability (CAI). If patients at risk could be identified, they could receive adequate and on-time treatment. OBJECTIVE The purpose of the current review was to identify all reported intrinsic factors associated with sustaining a LAS or progressing to CAI after an initial sprain. EVIDENCE REVIEW PubMed, Embase, MEDline, Cochrane and PEDro were searched for studies published until July 2019. Articles were selected if they included intrinsic factors related to LAS or CAI, subjects of at least 16 years old, and contained a minimum of 10 patients and 10 controls. Studies were excluded if they concerned reviews or case reports, included patients with previous surgical interventions, concomitant injuries or joint pathology other than ankle instability. Quality of included studies was assessed using the Quality in Prognostic Studies tool and quality of evidence was assessed using the GRADEpro tool. In case outcomes were described by at least three studies, data were pooled and assessed by performing a meta-analysis. Based on the pooled data, either a fixed-effects model or random-effects model was selected to correct for the degree of heterogeneity. FINDINGS The search resulted in a total of 4154 studies. After title and abstract screening and subsequent full-text screening, 80 relevant studies were included. Results of the meta-analyses indicated that, compared with healthy controls, patients with LAS had a higher mean body mass index (BMI). In patients with CAI, a higher weight and a longer time to stabilise after performing a task (eg, jumping) were found compared with healthy controls. Other outcomes could not be compared using a meta-analysis due to heterogeneity in outcome measurement and the great number of different outcomes reported. Identification of the risk factors when patients present themselves after a LAS may help to determine which patients are at risk of recurrent sprains or developing CAI. CONCLUSIONS AND RELEVANCE Based on the findings in this review, a higher BMI, and a higher weight and neuromuscular stability deficits may be regarded risk factors for sustaining a LAS or developing CAI, respectively. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Gwendolyn Vuurberg
- Orthopaedic surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands .,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Nienke Altink
- Orthopaedic surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Morteza Rajai
- Orthopaedic surgery, Iran University of Medical Sciences, Tehran, the Islamic Republic of Iran
| | - Leendert Blankevoort
- Orthopaedic surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Orthopaedic surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
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10
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Vuurberg G, Dahmen J, Dobbe J, Kleipool R, Stufkens S, Maas M, Kerkhoffs G, van Dijk C, Streekstra G. The effect of foot rotation on measuring ankle alignment using simulated radiographs: a safe zone for pre-operative planning. Clin Radiol 2019; 74:897.e1-897.e7. [DOI: 10.1016/j.crad.2019.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
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11
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Tümer N, Vuurberg G, Blankevoort L, Kerkhoffs GMMJ, Tuijthof GJM, Zadpoor AA. Typical Shape Differences in the Subtalar Joint Bones Between Subjects with Chronic Ankle Instability and Controls. J Orthop Res 2019; 37:1892-1902. [PMID: 31042001 PMCID: PMC6772087 DOI: 10.1002/jor.24336] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/23/2019] [Indexed: 02/04/2023]
Abstract
Bone shapes, particularly those defining the subtalar joint (STJ), have not received much attention yet as a risk factor for developing chronic ankle instability (CAI) after sustaining a lateral ankle sprain (LAS). This study aimed to compare three-dimensional (3D) shape variations in the STJ bones within individuals with CAI and healthy controls. 3D statistical shape models (SSMs) of the STJ bones were built to describe the bone shape variations observed within a population consisting of 26 individuals with unilateral CAI and 26 healthy controls. Using the SSMs and analysis of covariance test, age- and gender-adjusted shape variations in the bones were compared within individuals with CAI and healthy controls. The mean age of the CAI patients (14 males and 12 females) and healthy controls (12 males and 14 females) was 29 (standard deviation [SD] = 11) and 36 years (SD = 11), respectively. Tali and calcanei did not significantly vary between ipsilateral CAI and their contralateral ankle. Two shape modes, one for the talus (p = 0.015, variations in the curvature of the talar lateral process and the inclination angle of the talar neck relative to the body) and one for the calcaneus (p = 0.003, variations in the medial and lateral tuberosities, and the contour of the anterior articular surface), described significant shape differences between the CAI patients and healthy controls. The CAI patients generally had flatter talar joint surfaces and a flattened calcaneal ground-contact surface. These findings suggest that specific bone shapes may increase the risk of developing CAI after sustaining a LAS. © 2019 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:1892-1902, 2019.
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Affiliation(s)
- Nazlı Tümer
- Department of Biomechanical EngineeringDelft University of Technology (TU Delft)DelftThe Netherlands
| | - Gwendolyn Vuurberg
- Department of Orthopaedic Surgery, Amsterdam UMC, University of AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands,Academic Center for Evidence‐based Sports Medicine (ACES)AmsterdamThe Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS)AMC/VUmc IOC Research CenterAmsterdamThe Netherlands
| | - Leendert Blankevoort
- Department of Orthopaedic Surgery, Amsterdam UMC, University of AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands,Academic Center for Evidence‐based Sports Medicine (ACES)AmsterdamThe Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS)AMC/VUmc IOC Research CenterAmsterdamThe Netherlands
| | - Gino M M. J. Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands,Academic Center for Evidence‐based Sports Medicine (ACES)AmsterdamThe Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS)AMC/VUmc IOC Research CenterAmsterdamThe Netherlands
| | - Gabrielle J. M. Tuijthof
- Department of Orthopaedic Surgery, Amsterdam UMC, University of AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands,Academic Center for Evidence‐based Sports Medicine (ACES)AmsterdamThe Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS)AMC/VUmc IOC Research CenterAmsterdamThe Netherlands,Research Centre Smart DevicesZuyd University of Applied SciencesHeerlenThe Netherlands
| | - Amir A. Zadpoor
- Department of Biomechanical EngineeringDelft University of Technology (TU Delft)DelftThe Netherlands
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12
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Vuurberg G, Vos J, Christoph L, de Vos R. The effectiveness of interprofessional classroom-based education in medical curricula: A systematic review. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.xjep.2019.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Vuurberg G, Wink LM, Sierevelt IN, Jens S, Hemke R, de Boer MA, den Butter E, Kerkhoffs GMMJ, Maas M. Risk of chronic ankle instability: A reliability study on radiographic assessment of the ankle joint geometry. Foot (Edinb) 2019; 38:12-18. [PMID: 30530188 DOI: 10.1016/j.foot.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 10/17/2018] [Accepted: 11/05/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic ankle instability (CAI) is a multifactorial disabling condition. Ideally all factors contributing to CAI are identified and implemented in a risk assessment model. However, they need to meet strict reliability requirements. To assess usability of radiographic factors for this risk assessment model and future clinical practice, the objective of the current study was to assess the intra and inter observer reliability of three radiographic measurements. METHODS AND METHODS The radiographs of 39 consecutive patients, at least 16years, who visited the Emergency Department after sustaining a lateral ankle sprain (LAS), were assessed by four observers. The radiographic measurements included absolute and relative ankle alignment, sagittal fibular position and ankle joint congruency (talar radius and height, and tibiotalar sector), performed twice by all observers independently. Reliability was assessed by calculating the Intraclass Correlation Coefficient (ICC) which was considered good when ICC>0.70. RESULTS The intra observer reliability of the absolute and relative fibular position, and talar height were good to excellent, (ICC 0.84-0.98, 0.85-0.98, and 0.79-0.93, respectively). The talar radius (ICC 0.69-0.89) was moderate to good. The overall inter observer reliability was good for the absolute and relative fibular position, and talar radius (ICC 0.84, 0.86, and 0.79, respectively). Other measurements had ICC values of <0.70. CONCLUSIONS In an effort to identify the multifactorial nature of CAI, both the fibular position and the talar radius measurements showed good observer reliability, and will be implemented in a future risk assessment models. The other measurements are too prone for measurement errors, for future reference. LEVEL OF EVIDENCE IV Case Series.
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Affiliation(s)
- Gwendolyn Vuurberg
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, The Netherlands.
| | - Lauren M Wink
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Slotervaart Center of Orthopedic Research & Education (SCORE), Slotervaart Medical Center, Department of Orthopedic Surgery, Louwesweg 6, 1066 EC Amsterdam, The Netherlands
| | - Sjoerd Jens
- Amsterdam UMC, University of Amsterdam, Department of Musculoskeletal Radiology, The Netherlands
| | - Robert Hemke
- Amsterdam UMC, University of Amsterdam, Department of Musculoskeletal Radiology, The Netherlands
| | - Maarten A de Boer
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | | | - Gino M M J Kerkhoffs
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, The Netherlands
| | - M Maas
- Academic Center for Evidence based Sports medicine (ACES), The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, The Netherlands; Amsterdam UMC, University of Amsterdam, Department of Musculoskeletal Radiology, The Netherlands; Musculoskeletal Imaging Quantification Center (MIQC), The Netherlands
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14
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Vuurberg G, Reilingh ML, van Bergen CJA, van Eekeren ICM, Gerards RM, van Dijk CN. Metal Resurfacing Inlay Implant for Osteochondral Talar Defects After Failed Previous Surgery: A Midterm Prospective Follow-up Study: Response. Am J Sports Med 2019; 47:NP19-NP20. [PMID: 30781982 DOI: 10.1177/0363546518817770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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15
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Vuurberg G, Wink LM, Blankevoort L, Haverkamp D, Hemke R, Jens S, Sierevelt IN, Maas M, Kerkhoffs GMMJ. A risk assessment model for chronic ankle instability: indications for early surgical treatment? An observational prospective cohort - study protocol. BMC Musculoskelet Disord 2018; 19:225. [PMID: 30021553 PMCID: PMC6052530 DOI: 10.1186/s12891-018-2124-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/05/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Chronic ankle instability (CAI) is a common result of an ankle sprain. Even though early surgical treatment yields the best results, overall only professional athletes are eligible for acute surgical stabilization. Treating all patients with early surgical stabilization leads to a high amount of unnecessary invasive interventions, as not all patients progress to CAI. If patients at risk of developing CAI can be identified, treatment policies may be applied more effectively and efficiently. The purpose of this study is to develop a risk assessment model to identify patients at risk for CAI that should receive early surgical treatment. METHODS In this observational prospective cohort, all patients aged sixteen years and older, reporting at the emergency department of one of the participating hospitals after sustaining a lateral ankle sprain, and filled out 1 out of 3 follow-up questionnaires and the 1 year follow-up are included. A lateral and anteroposterior radiograph is made. Patients are excluded if a fracture or other pathology is present. The included patients receive four questionnaires, including questions focusing on the sprain, treatment and complaints, the Foot and Ankle Outcome Score and the Cumberland Ankle Instability Tool. A total of eleven radiographic variables are assessed for inter- and intra-observer reliability. Additionally, four factors extracted from the questionnaires, will be evaluated for correlation with CAI. Significantly correlating factors (e.a. risk factors) will be implemented in a risk assessment model. For the final model, based on sixteen variables with a minimum of 20 events per variable and a prevalence of 30-40% after an initial sprain, a sample size of 2370 patients is needed to perform both internal and external model validation. DISCUSSION This study will develop the first large scale model for the risk at CAI after an ankle sprain combining radiographic and patient characteristics. With this risk assessment model, patients at risk for CAI may be identified and properly informed on the treatment options. Patients identified as being at risk, may receive more adequate follow-up and become eligible for early surgical stabilization. This prevents patients from experiencing unnecessary long-lasting complaints, increasing the success rate of conservative and surgical treatment. TRIAL REGISTRATION Retrospectively registered: NCT02955485 [Registration date: 3-11-2016]. NTR6139 [Registration date: 3-1-2017].
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Affiliation(s)
- Gwendolyn Vuurberg
- Orthopaedic Research Center Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
- Department of Musculoskeletal Radiology, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Lauren M. Wink
- Orthopaedic Research Center Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, VU Medical Center, Department of Surgery, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Orthopaedic Research Center Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Daniel Haverkamp
- Slotervaart Medical Center, Department of Orthopedic Surgery, Louwesweg 6, 1066 EC Amsterdam, The Netherlands
- Slotervaart Center of Orthopedic Research & Education (SCORE), Amsterdam, The Netherlands
| | - Robert Hemke
- Department of Musculoskeletal Radiology, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sjoerd Jens
- Department of Musculoskeletal Radiology, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Inger N. Sierevelt
- Slotervaart Medical Center, Department of Orthopedic Surgery, Louwesweg 6, 1066 EC Amsterdam, The Netherlands
- Slotervaart Center of Orthopedic Research & Education (SCORE), Amsterdam, The Netherlands
| | - Mario Maas
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
- Department of Musculoskeletal Radiology, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Orthopaedic Research Center Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
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16
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Vuurberg G, Reilingh ML, van Bergen CJ, van Eekeren IC, Gerards RM, van Dijk CN. Metal Resurfacing Inlay Implant for Osteochondral Talar Defects After Failed Previous Surgery: A Midterm Prospective Follow-up Study. Am J Sports Med 2018; 46:1685-1692. [PMID: 29624081 PMCID: PMC5985591 DOI: 10.1177/0363546518764916] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of osteochondral talar defects (OCDs) after failed previous surgery is challenging. Promising short-term results have been reported with use of a metal resurfacing inlay implant. PURPOSE To evaluate the midterm clinical effectiveness of the metal implant for OCDs of the medial talar dome after failed previous surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS We prospectively studied all patients who met the inclusion criteria and received a metal resurfacing inlay implant between 2007 and 2014. The primary outcome measure was implant survival, as measured by reoperation rate. Secondary outcome measures were numeric rating scales for pain at rest and during walking, running, and stair climbing; the Foot and Ankle Outcome Score (FAOS); the American Orthopaedic Foot and Ankle Society Ankle Hindfoot Scale; the 36-Item Short Form Health Survey (SF-36); return to work and sports; and radiographic evaluation. RESULTS This study included 38 patients with a mean age of 39 years (SD, ±13 years) and a mean follow-up of 5.1 years (SD, ±1.5 years). Two patients (5%) underwent revision surgery by means of an ankle arthrodesis (2 and 6 years postoperatively). In 8 patients, computed tomography scanning was conducted to assess postoperative complaints. These scans showed impression of the tibial plafond (n = 4), a small tibial cyst (<2.5 mm; n = 1), and cyst formation around the implant screw (n = 4). A total of 21 reoperations were performed, including medial malleolar screw removal (n = 12), arthroscopic removal of bony anterior impingement (n = 7), and calcaneal realignment osteotomy (n = 2). All secondary outcome measures improved significantly, apart from pain at rest, the FAOS symptoms subscale, and the SF-36 mental component scale. The mean time for return to sport was 4.1 months (SD, ±3 months), and 77% of patients resumed sporting activities postoperatively. Only 1 patient did not return to work postoperatively. Radiographs at final follow-up showed cyst formation (n = 2), subchondral periprosthetic radiolucency (n = 2), and non-preexisting joint space narrowing (n = 2). CONCLUSION This study shows that the metal implant is an effective technique when assessed at midterm follow-up for OCDs of the medial talar dome after failed previous surgery.
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Affiliation(s)
- Gwendolyn Vuurberg
- Orthopaedic Research Center Amsterdam, Academic Medical Center, Department of Orthopaedic Surgery, Amsterdam, the Netherlands,Gwendolyn Vuurberg, Orthopaedic Research Center Amsterdam, Academic Medical Center, Department of Orthopaedic Surgery, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands ()
| | - Mikel L. Reilingh
- Academic Medical Center, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
| | | | - Inge C.M. van Eekeren
- Academic Medical Center, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
| | - Rogier M. Gerards
- Academic Medical Center, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
| | - C. Niek van Dijk
- Academic Medical Center, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
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17
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Vuurberg G, Hoorntje A, Wink LM, van der Doelen BFW, van den Bekerom MP, Dekker R, van Dijk CN, Krips R, Loogman MCM, Ridderikhof ML, Smithuis FF, Stufkens SAS, Verhagen EALM, de Bie RA, Kerkhoffs GMMJ. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med 2018. [PMID: 29514819 DOI: 10.1136/bjsports-2017-098106] [Citation(s) in RCA: 182] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This guideline aimed to advance current understandings regarding the diagnosis, prevention and therapeutic interventions for ankle sprains by updating the existing guideline and incorporate new research. A secondary objective was to provide an update related to the cost-effectiveness of diagnostic procedures, therapeutic interventions and prevention strategies. It was posited that subsequent interaction of clinicians with this guideline could help reduce health impairments and patient burden associated with this prevalent musculoskeletal injury. The previous guideline provided evidence that the severity of ligament damage can be assessed most reliably by delayed physical examination (4-5 days post trauma). After correct diagnosis, it can be stated that even though a short time of immobilisation may be helpful in relieving pain and swelling, the patient with an acute lateral ankle ligament rupture benefits most from use of tape or a brace in combination with an exercise programme.New in this update: Participation in certain sports is associated with a heightened risk of sustaining a lateral ankle sprain. Care should be taken with non-steroidal anti-inflammatory drugs (NSAIDs) usage after an ankle sprain. They may be used to reduce pain and swelling, but usage is not without complications and NSAIDs may suppress the natural healing process. Concerning treatment, supervised exercise-based programmes preferred over passive modalities as it stimulates the recovery of functional joint stability. Surgery should be reserved for cases that do not respond to thorough and comprehensive exercise-based treatment. For the prevention of recurrent lateral ankle sprains, ankle braces should be considered as an efficacious option.
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Affiliation(s)
- Gwendolyn Vuurberg
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands
| | - Alexander Hoorntje
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands
| | - Lauren M Wink
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,VU Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Brent F W van der Doelen
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands
| | | | - Rienk Dekker
- Dutch Society of Rehabilitation, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - C Niek van Dijk
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands
| | - Rover Krips
- Department of Orthopaedic Surgery, Flevoziekenhuis, Almere, The Netherlands
| | | | | | - Frank F Smithuis
- Department of Musculoskeletal Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Evert A L M Verhagen
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands.,VU Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of of Public and Occupational Health VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Rob A de Bie
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands
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Vuurberg G, Pereira H, Blankevoort L, van Dijk CN. Anatomic stabilization techniques provide superior results in terms of functional outcome in patients suffering from chronic ankle instability compared to non-anatomic techniques. Knee Surg Sports Traumatol Arthrosc 2018; 26:2183-2195. [PMID: 29138918 PMCID: PMC6061442 DOI: 10.1007/s00167-017-4730-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/25/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine the best surgical treatment for chronic ankle instability (CAI) a systematic review was performed to compare the functional outcomes between various surgical stabilization methods. METHODS A systematic search was performed from 1950 up to April 2016 using PubMed, EMBASE, Medline and the Cochrane Library. Inclusion criteria were a minimum age of 18 years, persistent lateral ankle instability, treatment by some form of surgical stabilization, described functional outcome measures. Exclusion criteria were case reports, (systematic) reviews, articles not published in English, description of only acute instability or only conservative treatment, medial ankle instability and concomitant injuries, deformities or previous surgical treatment for ankle instability. After inclusion, studies were critically appraised using the Modified Coleman Methodology Score. RESULTS The search resulted in a total of 19 articles, including 882 patients, which were included in this review. The Modified Coleman Methodology Score ranged from 30 to 73 points on a scale from 0 to 90 points. The AOFAS and Karlsson Score were the most commonly used patient-reported outcome measures to assess functional outcome after surgery. Anatomic repair showed the highest post-operative scores [AOFAS 93.8 (SD ± 2.7; n = 119); Karlsson 95.1 (SD ± 3.6, n = 121)], compared to anatomic reconstruction [AOFAS 90.2 (SD ± 10.9, n = 128); Karlsson 90.1 (SD ± 7.8, n = 35)] and tenodesis [AOFAS 86.5 (SD ± 12.0, n = 10); Karlsson 85.3 (SD ± 2.5, n = 39)]. Anatomic reconstruction showed the highest score increase after surgery (AOFAS 37.0 (SD ± 6.8, n = 128); Karlsson 51.6 (SD ± 5.5, n = 35) compared to anatomic repair [AOFAS 31.8 (SD ± 5.3, n = 119); Karlsson 40.9 (SD ± 2.9, n = 121)] and tenodesis [AOFAS 19.5 (SD ± 13.7, n = 10); Karlsson 29.4 (SD ± 6.3, n = 39)] (p < 0.005). CONCLUSION Anatomic reconstruction and anatomic repair provide better functional outcome after surgical treatment of patients with CAI compared to tenodesis reconstruction. These results further discourage the use of tenodesis reconstruction and other non-anatomic surgical techniques. Future studies may be required to indicate potential value of tenodesis reconstruction when used as a salvage procedure. Not optimal, but the latter still provides an increase in functional outcome post-operatively. Anatomic reconstruction seems to give the best results, but may be more invasive than anatomic repair. This has to be kept in mind when choosing between reconstruction and repair in the treatment of CAI. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- G. Vuurberg
- Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam Movement Sciences, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands ,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - H. Pereira
- Centro Hospitalar Póvoa de Varzim – Vila do Conde, Póvoa de Varzim, Portugal ,ICVS/3B’s—PT Government Associated Laboratory, University of Minho, Braga, Guimarães, Portugal ,Ripoll y De Prado Sports Clinic: Murcia-Madrid—FIFA Medical Center of Excellence, Madrid, Spain
| | - L. Blankevoort
- Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam Movement Sciences, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands ,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - C. N. van Dijk
- Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam Movement Sciences, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands ,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands ,Ripoll y De Prado Sports Clinic: Murcia-Madrid—FIFA Medical Center of Excellence, Madrid, Spain
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19
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Vuurberg G, Kluit L, van Dijk CN. The Cumberland Ankle Instability Tool (CAIT) in the Dutch population with and without complaints of ankle instability. Knee Surg Sports Traumatol Arthrosc 2018; 26:882-891. [PMID: 27714439 PMCID: PMC5847203 DOI: 10.1007/s00167-016-4350-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/28/2016] [Indexed: 01/12/2023]
Abstract
PURPOSE To develop a translated Dutch version of the Cumberland Ankle Instability Tool (CAIT) and test its psychometric properties in a Dutch population with foot and ankle complaints. METHODS The CAIT was translated into the Dutch language using a forward-backward translation design. Of the 130 subsequent patients visiting the outpatient clinic for foot and ankle complaints who were asked to fill out a questionnaire containing the CAIT, the Foot and Ankle Outcome Score (FAOS), and the numeric rating scale (NRS) pain, 98 completed the questionnaire. After a 1-week period, patients were asked to fill out a second questionnaire online containing the CAIT and NRS pain. This second questionnaire was completed by 70 patients. With these data, the construct validity, test-retest reliability, internal consistency, measurement error, and ceiling and floor effects were assessed. Additionally, a cut-off value to discriminate between stable and unstable ankles, in patients with ankle complaints, was calculated. RESULTS Construct validity showed moderate correlations between the CAIT and FAOS subscales (Spearman's correlation coefficient (SCC) = 0.36-0.43), and the NRS pain (SCC = -0.55). The cut-off value was found at 11.5 points of the total CAIT score (range 0-30). Test-retest reliability showed to be excellent with an intraclass correlation coefficient of 0.94. Internal consistency was high (Cronbach's α = 0.86). No ceiling or floor effects were detected. CONCLUSION Based on the results, the Dutch version of the CAIT is a valid and reliable questionnaire to assess ankle instability in the Dutch population and is able to differentiate between a functionally unstable and stable ankle. The tool is the first suitable tool to objectify the severity of ankle instability specific complaints and assess change in the Dutch population. Level of evidence II.
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Affiliation(s)
- Gwendolyn Vuurberg
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Lana Kluit
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Centre, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - C. Niek van Dijk
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Centre, PO Box 22660, 1100 DD Amsterdam, The Netherlands
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Pereira H, Vuurberg G, Spennacchio P, Batista J, D’Hooghe P, Hunt K, Van Dijk N. Surgical Treatment Paradigms of Ankle Lateral Instability, Osteochondral Defects and Impingement. Osteochondral Tissue Engineering 2018; 1059:85-108. [DOI: 10.1007/978-3-319-76735-2_4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Pereira H, Vuurberg G, Stone J, Lui TH. Ankle tendoscopy: state of the art. J ISAKOS 2017. [DOI: 10.1136/jisakos-2017-000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
BACKGROUND Capsular shrinkage is an arthroscopic stabilization technique that can be used in patients with chronic ankle instability (CAI), if desired in addition to primary arthroscopic procedures. Despite positive short-term results, long-term follow-up of these patients has not yet been performed. Therefore, our objective was to assess whether capsular shrinkage still provided functional outcome after 12-14 years compared to preoperative scores. METHODS This study was a retrospective long-term follow-up of a prospectively conducted longitudinal multicenter trial. The study duration was from February 2002 to September 2016, including a preoperative assessment and short-, mid-, and long-term follow-up. At the time of inclusion, patients were diagnosed with CAI, >18 years old, were unresponsive to conservative treatment, and had confirmed mechanical ankle joint laxity. Patients were excluded if the talar tilt was greater than 15 degrees, if they had received previous operative treatment, or had constitutional hyperlaxity, systemic diseases, or osteoarthritis grade II or III. The primary outcome was the change in functional outcome as assessed by the Karlsson score. RESULTS Twenty-five patients of the initial 39 were available for this follow-up. This group had a mean age of 43.2 years (SD±11.1) and included 15 males. A statistically significant improvement was found in the Karlsson score at 12-14 years (76.6 points; SD±25.5) relative to the preoperative status (56.4 points; SD ±13.3; P < .0005). Although 17 patients (68%) reported recurrent sprains, 23 patients (92%) stated that they were satisfied with the procedure. CONCLUSIONS Despite improved functional outcome and good satisfaction in patients with CAI after capsular shrinkage, recurrence rates and residual symptoms were high. For this reason, arthroscopic capsular shrinkage is not recommended as joint stabilization procedure in patients with CAI. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Gwendolyn Vuurberg
- Academic Medical Center, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands,Academic Center for Evidence based Sports medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, the Netherlands,Gwendolyn Vuurberg, Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Centre, PO Box 22660, 1100 DD Amsterdam, the Netherlands.
| | - Jasper S. de Vries
- Amstelland ziekenhuis, Department of Orthopaedic Surgery, Amstelveen, the Netherlands
| | - Rover Krips
- Flevoziekenhuis, Department of Orthopaedic Surgery, Almere, the Netherlands
| | - Leendert Blankevoort
- Academic Medical Center, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Alex W.F.M. Fievez
- Medinova clinic, Breda, Amphia hospital, Department of Orthopaedic Surgery, Breda, the Netherlands
| | - C. Niek van Dijk
- Academic Medical Center, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands,Academic Center for Evidence based Sports medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, the Netherlands
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Vuurberg G, de Vries JS, Krips R, Blankevoort L, Fievez AWFM, van Dijk CN. Arthroscopic Capsular Shrinkage for Treatment of Chronic Lateral Ankle Instability. Foot Ankle Int 2017. [PMID: 28745068 DOI: 10.1177/1071100717718139.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Capsular shrinkage is an arthroscopic stabilization technique that can be used in patients with chronic ankle instability (CAI), if desired in addition to primary arthroscopic procedures. Despite positive short-term results, long-term follow-up of these patients has not yet been performed. Therefore, our objective was to assess whether capsular shrinkage still provided functional outcome after 12-14 years compared to preoperative scores. METHODS This study was a retrospective long-term follow-up of a prospectively conducted longitudinal multicenter trial. The study duration was from February 2002 to September 2016, including a preoperative assessment and short-, mid-, and long-term follow-up. At the time of inclusion, patients were diagnosed with CAI, >18 years old, were unresponsive to conservative treatment, and had confirmed mechanical ankle joint laxity. Patients were excluded if the talar tilt was greater than 15 degrees, if they had received previous operative treatment, or had constitutional hyperlaxity, systemic diseases, or osteoarthritis grade II or III. The primary outcome was the change in functional outcome as assessed by the Karlsson score. RESULTS Twenty-five patients of the initial 39 were available for this follow-up. This group had a mean age of 43.2 years (SD±11.1) and included 15 males. A statistically significant improvement was found in the Karlsson score at 12-14 years (76.6 points; SD±25.5) relative to the preoperative status (56.4 points; SD ±13.3; P < .0005). Although 17 patients (68%) reported recurrent sprains, 23 patients (92%) stated that they were satisfied with the procedure. CONCLUSIONS Despite improved functional outcome and good satisfaction in patients with CAI after capsular shrinkage, recurrence rates and residual symptoms were high. For this reason, arthroscopic capsular shrinkage is not recommended as joint stabilization procedure in patients with CAI. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Gwendolyn Vuurberg
- 1 Academic Medical Center, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,2 Academic Center for Evidence based Sports medicine (ACES), Amsterdam, the Netherlands.,3 Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, the Netherlands
| | - Jasper S de Vries
- 4 Amstelland ziekenhuis, Department of Orthopaedic Surgery, Amstelveen, the Netherlands
| | - Rover Krips
- 5 Flevoziekenhuis, Department of Orthopaedic Surgery, Almere, the Netherlands
| | - Leendert Blankevoort
- 1 Academic Medical Center, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Alex W F M Fievez
- 6 Medinova clinic, Breda, Amphia hospital, Department of Orthopaedic Surgery, Breda, the Netherlands
| | - C Niek van Dijk
- 1 Academic Medical Center, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,2 Academic Center for Evidence based Sports medicine (ACES), Amsterdam, the Netherlands.,3 Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, the Netherlands
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Vuurberg G, Veen OC, Pereira H, Blankevoort L, van Dijk CN. Tenodesis reconstruction in patients with chronic lateral ankle instability is associated with a high risk of complications compared with anatomic repair and reconstruction: a systematic review and meta-analysis. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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van Dijk CN, Vuurberg G. There is no such thing as a simple ankle sprain: clinical commentary on the 2016 International Ankle Consortium position statement. Br J Sports Med 2016; 51:485-486. [PMID: 27797735 DOI: 10.1136/bjsports-2016-096733] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 12/26/2022]
Affiliation(s)
- C Niek van Dijk
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.,Academic Center for Evidence based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Gwendolyn Vuurberg
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.,Academic Center for Evidence based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
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Affiliation(s)
- Gwendolyn Vuurberg
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands Academic Center for Evidence based Sports medicine (ACES) Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center AMC/VUmc
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands Academic Center for Evidence based Sports medicine (ACES) Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center AMC/VUmc
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Ferreira C, Vuurberg G, Oliveira JM, Espregueira-Mendes J, Pereira H, Reis RL, Ripoll PL. Good clinical outcome after osteochondral autologous transplantation surgery for osteochondral lesions of the talus but at the cost of a high rate of complications: a systematic review. J ISAKOS 2016. [DOI: 10.1136/jisakos-2015-000020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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